Always good to read your name. Was thinking the other day how nice it would be to visit your city. Maybe after tx when I have the requiste energy. Don't know much, have read little, about ammonia levels. But if you read the post in a thread started by Pluggin Away yesterday he makes reference to ammonia levels, brain scatter (great term) and lactuose. Just a few threads down. Take care.
Sorry, that's Plugginalong's thread
I had high ammonia levels from cirrhosis. It does make your brian foggy. The thing is, its all so insidious, it happens slowly. So I didn't know how out of it I was until I started taking lactulose to reduce the ammonia. And then, surprise, I stopped taking naps, my brain was working better. Don't deny yourself the possibility of feeling better.
Increased ammonia levels are related to liver damage not the treatment drugs. Did your doctor say what the levels were? Did he put you on meds for it? Are you seeing a Heptologist?
Elevated ammonia levels in the setting of cirrhosis are the result of the reduced capacity of the liver to convert the ammonia produced by the intestinal bacteria from protein remnants in the food to urea, which is non toxic to our metabolism and can be excreted effciently in the kidneys. Ammonia ( and some other ill defined toxic byproducts of intestinal bacteria metabolism) is particular toxic to the brain and can cause , at first, mild subclinical encephalopathy as is often seen even in compensated cirrhosis using sensitive psychometric testing. At higher levels it can cause acute hepatic encephalopathy, which is one of the deadly acute complications of cirrhosis. It is treated with high dose lactulose, which has the effect to reduce the number of ammonia producing intenstinal flora in favor of lactulose ( a non absorbable harmless, nontoxic sugar, available OTC in Canada and Europe for laxative purposes) utilizing bacteria, that are harmless and do not produce ammonia. This is a life saving treatment. There is little reason not to use lactulose as a preventative probiotic treatment for anyone with liver problems.
HR, it sounds to me like your comments are once again spot on. I have 'early cirrhosis' and I've noticed that I'm rarely running on all mental cylinders. Not bad, but not great. Like a missfiring Volkswagan when I'm used to functioning like a smoke belching Rambler...
I have a brand new shiny lactulose script waiting to be picked up at Long's.
My Doc and I discussed the issue and settled on trying this just to see what will happen. We talked about the sensitive tests required for minimal encephalopathy and how individuals who's professions or lifestyles require more concentration might sense the problem earlier. I haven't figured out how the tests would work without a baseline....seems to me mental function is relative, no?
He didn't offer to test amonia, which strikes me as odd.
As far as the downside, the Doc was reluctant due to the potential disruption to the bowels. He says theraputic benefit woun't be realized until I titrate up in dose to reach 2 movements a day. I wished we had started dooner - it would have provided me something to talk about at the holiday parties. Fire in the hole......
Seriously though, he leaves it to me to decide how much I want to take and I think I'll lean to the low side so as not to have too many pooper problems. I wonder whether I can benefit without being tethered too closely to the can?